Bill would require 'track changes' on electronic medical records

A bill working its way through the state Legislature would make it more difficult for health care providers to modify or delete electronic medical records and leave no record of the change.

“Changes to an EHR (electronic health record) can go unnoticed and can be harder to trace than changes made to paper records,” said Sen. Mark Leno, D-San Francisco, the author of SB 850, in a hearing last month. The bill passed the Senate on May 31. It will be heard in the Assembly's Health and Judiciary committees in the next few weeks.

Supporters of the bill point to the case of Diane Stewart, a woman who died suddenly following a knee operation at the Stanford University Medical Center a few years ago, as evidence of why such measures are needed. Investigators at the state Department of Public Health found that relevant portions of Stewart's computer file had been erased after her death and that a nurse was instructed to make postmortem entries to describe her care. Stewart's family alleged that hospital employees tried to cover up their error. The hospital has denied any wrongdoing in the case, according to Hearst Newspapers.

Christopher Dolan, the attorney who represented the Stewart family, says that under current federal guidelines, health care providers do not have to track what is changed in a medical record. He says medical records are extremely easy to manipulate when they're in electronic form, noting that it can be cost-prohibitive for victims to investigate and seek redress for their injuries if they have to hire specialists to investigate potential cover-ups.

p>The bill would require providers to automatically record any change or deletion of electronically stored medical information and identify who made the change. Furthermore, the bill would make it possible for patients to see the changes if they requested their medical records.

"Our system can't do that, and we're not aware of any system that can," said Teresa Stark of Kaiser Permanente, according to California Healthline. "Given the level of investment required to bring our EHR up to that level, is this really what we want to be spending our money on?"

The California Medical Association and the California Hospital Association also have expressed concerns.

"While the use of electronic records provides new challenges to documentation, CHA believes the frequency of the problem addressed in this bill does not make the cost justified at this time when hospitals are focused on achieving sustainable health information exchange and in demonstrating federally defined meaningful use of clinical data," the California Hospital Association wrote in a letter to Leno.

Across the state, California physicians have been adopting electronic records at rapid speed. Nearly half of physician practices have electronic medical records in place, up from 14 percent in 2008, according to a recent report from the California HealthCare Foundation.

Paloma Perez, associate legislative counsel for the Consumer Attorneys of California, which sponsored the bill, says the legislation isn't just trying to prevent medical cover-ups. She points to situations in which medical records were missing information due to accidental data entry errors, noting that such errors could make it impossible for a health care provider to adequately evaluate and treat a patient.

“This is a classic example of technology having a double-edged sword because it obviously offers great benefits, but there's room for mistakes to happen if we don't do what SB 850 is trying to accomplish,” Perez said.

At the federal level, the Centers for Medicare & Medicaid Services has paid more than $158.3 million in incentives to hospitals and doctors this year to encourage adoption of electronic health records.